Healthcare Provider Details

I. General information

NPI: 1730789868
Provider Name (Legal Business Name): ANGELA NICOLE HOTARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CYPRESS ST
WEST MONROE LA
71291-4555
US

IV. Provider business mailing address

218 NEW CHAPEL HILL RD
WEST MONROE LA
71291-1704
US

V. Phone/Fax

Practice location:
  • Phone: 318-267-3001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16604
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: